Neurosurgery Coding Alert

Question: Through anterior approach to the lumbar spine at L3 toS1, our surgeon did diskectomy L3-S1, bilateral foraminotomies L3-S1, partial corpectomies L3-S1, interbody arthrodesis with implantation of peek cage and morselized allograft L3-S1, and arthrodesis with titanium screws L3-S1.

How do we report this procedure? Can we bill the corpectomy as it basically done to prepare space for implantation of cage?

Florida Subscriber

Answer: When you refer to corpectomy as preparing the space for implantation of the cage, it is unlikely that more than one third of the vertebral body was removed, precluding use of the corpectomy codes 63090 (Vertebral corpectomy [vertebral body resection], partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root[s], lower thoracic, lumbar, or sacral; single segment) and 63091 (Vertebral corpectomy [vertebral body resection], partial or complete, transperitoneal or retroperitoneal approach with decompression of spinal cord, cauda equina or nerve root[s], lower thoracic, lumbar, or sacral; each additional segment [List separately in addition to code for primary procedure]).

You report the arthrodesis with 22558 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; lumbar) for the L3-L4 arthrodesis. You select code 22585 (Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace [other than for decompression]; each additional interspace [List separately in addition to code for primary procedure]) x 2 for arthodesis at L4-L5 and L5-S1. These codes include discectomy and bony removal required for placement of an interbody material including cage implantation. If a separately identifiable nerve decompression with foraminotomy was medically-necessary and performed, this would be reported with an unlisted code 64999.

The CPT® codes for corpectomy include discectomy, excision of osteophytes, and use of magnification or loupes. Arthrodesis, instrumentation, placement of halo, and harvesting and insertion of bone graft are excluded in corpectomy codes. You should be careful in reading the procedure as surgeons often drill adjacent upper and lower endplates to remove posterior osteophytes and to improve visualization and access. For instrumentation, you report 22846 (Anterior instrumentation; 4 to 7 vertebral segments [List separately in addition to code for primary procedure]) and for graft you report 20930 (Allograft, morselized, for spine surgery only [List separately in addition to code for primary procedure]) and 22851 (Application of intervertebral biomechanical device[s] [eg, synthetic cage[s], methylmethacrylate] to vertebral defect or interspace [List separately in addition to code for primary procedure]) for each interspace that a PEEK cage was placed.